The ethics of Cord clamping and stem cell
collection

This afternoon Radio New Zealand, Jim
Mora interviewed Professor Bob
Williamson (download
mp3 here)
about research on stem cells which come
from cord blood. Jim asked Professor
Williamson whether there are any ethical
issues surrounding cord blood stem
cells. He replied that there weren’t.

The key to harvesting cord blood is
when you clamp the cord. There are
various terms relating to cord cutting.
The first term is “immediate clamping”
which means that a clamp is put on the
cord, the minute a baby comes out of the
mother. The second is “delayed
clamping” which to doctors means that
the clamp is put on any time after
“immediate” but to homebirth midwives,
means that the cord isn’t clamped until
all the blood has been pumped by the
uterus into the baby and the cord has
gone white.

In terms of obstetrics history
“immediate” cord clamping is a
relatively new “routine” procedure, and
is now pretty much standard practice in
hospitals.

That immediate cord clamping is
inherently wrong and potentially
dangerous to babies, isn’t talked about
much.

Immediate cord clamping has its roots in
the mid 20th century following an
observation that babies appeared to be
getting more jaundiced. This “problem”
had suddenly become more severe, after
it became fashionable for obstetricians
to routinely knock out labouring mothers
with various drugs. These drugs got
into babies. Babies started to get more
jaundiced. Obstetricians rationalized
that perhaps babies were getting too
much blood, so they decided to routinely
clamp the cord immediately, to stop the
jaundice.

Doctors didn’t realise was that the
drugs were taking up the bilirubin sites
on the red blood cells, preventing it’s
excretion in the “normal” timely manner,
building up dangerous levels of bilirubin.

The obstetricians compounded their first
monumental error of incorrect diagnosis,
with a second, even worse error. While
clamping the cord, sometimes stopped the
jaundice, it deprived the baby of two
thirds of its own blood, which has nasty
effects such as:

There are Obstetric Professors to
this day, who think immediate clamping
is "normal".

Perhaps you
are reading this wondering, “What is the
big deal?”

The deal is that immediate cord
clamping deprives babies of 200 mls of
blood. You look at 200 mls, and think
that’s not much. What if you knew that
without that
200 mls of blood, the baby only has 400
mls, instead of a total of 600 mls?

Immediate cord clamping is the
equivalent of removing one third of an
adults total blood supply (10 pints), or
three and one third pints. That is
classified as a severe haemorrhage.

But in babies, immediately cord clamping
is worse than a haemorrhage. The blood
in the cord and the placenta is what has
“breathed” for the baby, as well as
circulating food in, and waste out. the
baby needs that full quota of blood for
correct intracranial pressure, lower
blood volume, and to decrease the risk
of anaemia in later life. Furthermore,
there are unanswered questions about
whether depriving the baby of that
"abundant" supply of the stem cells
which Professor Williamson considers
have such wonderful medicinal prospects
when 'harvested', may contribute to the
development of serious diseases later in
life as a result.

So here is where I have an ethical about
cord blood collection. After a baby is
born, 150 mls of blood is collected with
a needle and vial from the umbilical
cord. In order to be ABLE to collect
150 mls, the cord has to be clamped
almost immediately after birth, and that
last 50 mls stays in the placenta.

If you left the cord until it’s gone
white, and shrivelled, the whole 200 mls
which is rightfully the baby’s, has gone
into the baby, so there is very little
cord blood to collect. Stem cell
harvesting can only be achieved by
depriving the baby of one third of it's
blood.

It is my belief that nothing should be
done to the cord until the baby has been
breathing for some time, and blood
equilibrium has been achieved. Balance
is achieved in the baby, through the
cord. Blood is pumped into the baby by
uterine contractions, and in the
unlikely event that there is too much,
it will go back down the “outflow” pipe
of the cord.

The practical realities are, that blood
hardly every comes back out. The cord
shrivels to white and hard, and the baby
automatically shuts off the cord itself.

Every doctor involved with stem cell
harvesting from cord blood, will tell
you: There is absolutely no
risk to you or your baby.
That is simply not true. The risks to
your baby must be identical to the risks
of immediate cord clamping. Why would
you want to do that? The only reason
you are told that there is no risk to
your baby, is that most doctors still
think any blood NOT in the baby at the
point of birth is superfluous.

Here to me is the ethical dilemma.
That 150 mls collected blood, so rich in
stem cells that doctors want them isn’t
superfluous. It is rightfully the
baby’s, and to deprive the baby of 150
mls is the same as immediate cord
clamping.

Professor Bob Williamson pointed out
that as we get older the numbers of stem
cells in our bodies drop markedly. The
question that appears to never have been
asked, or answered, as far as I know
is: “Are the stem cells,
that cord blood is so rich in, actually
vital to laying down a really good
foundation for a person’s health from
birth to death?”

In other words, “Does stem
cell harvesting rob James to cure John”?

While we are at it, let’s deal with
another bugbear of mine. Let’s stop the
unscientific, incorrect use
inverted phrasing, which
send the wrong messages to parents.